Better Vascular Cath Care Can Cut Blood Infections

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Explain that new guidelines issued by the CDC call for improved care and maintenance of intravascular catheters as a key element in reducing bloodstream infections resulting from the device.

In addition to proper handling, sterile techniques, and prophylaxis, the guidelines address the proper use of different types of intravascular devices, including central venous catheters and peripheral arterial catheters.

New guidelines issued by the CDC call for improved care and maintenance of intravascular catheters as a key element in reducing bloodstream infections resulting from the devices.

"We now know that care and maintenance is quite problematic," said Naomi O'Grady, MD, of the NIH, the lead author of the new guidelines and a previous set issued in 2002.

The 2002 guidelines had focused on precautions to be used around the time the catheter was inserted, O'Grady told MedPage Today, but those issues have been "well addressed," with a consequent reduction in bloodstream infections in intensive care units around the country.

But data published since then suggests that many infections arise owing to lapses in sterile precautions while the catheter is in place, O'Grady said.

"Attention to detail makes all the difference," she said.

For instance, O'Grady said, the new guidelines emphasize the need to make sure the catheter connector or hub is cleaned with an appropriate antibiotic.

"The point is to scrub that hub, rather than just swipe it," she added.

The guidelines also urge clinicians to use a catheter only as long as it is needed.

"Pull them out when you don't need them," O'Grady said.

She said catheters are often left in as a matter of convenience, in case of future need, but evidence suggests the "risk likely outweighs the benefit."

The earlier guidelines focused on intensive care units, a focus that is maintained in the 2011 document, largely because data from those units is routinely reported to the CDC.

In recent years, "we've seen a pretty substantial decrease in the number of catheter-related bloodstream infections in the ICU," O'Grady said.

Indeed, the CDC recently reported a 58% decrease in ICU bloodstream infections associated with central line catheters in 2009, compared with 2001.

But the advent of such things as electronic medical records means better information is now becoming available for general medical wards, as well as outpatient units, O'Grady said.

"We recognize there is an equally important problem with catheter-related bloodstream infections in the general medical wards," she said.

Indeed, the guidelines suggest that the "goal of an effective prevention program should be the elimination of (catheter-related bloodstream infections) from all patient-care areas."

The guidelines, released by the CDC, appear online in Clinical Infectious Diseases and are to form a supplement to the American Journal of Infection Control.

The CDC guidelines come as hospitals that accept Medicare patients are being required to report their central line-associated bloodstream infections to the Centers for Medicare & Medicaid Services, on pain of losing some of their reimbursements.

The new edition was developed by a working group, led by the Society of Critical Care Medicine, in collaboration with a range of academic and medical societies, as well as the CDC and its Healthcare Infection Control Practices Advisory Committee.

In addition to proper handling, sterile techniques, maintenance, and prophylaxis, the guidelines address the proper use of different types of intravascular devices, including central venous catheters and peripheral arterial catheters.

The guidelines are "rich with new recommendations that are based on additional scientific research that has emerged since the prior version was published," remarked Russell Olmsted, MPH, of St. Joseph Mercy Health System in Ann Arbor, Mich.

Among other things, they emphasize the importance of "a culture of safety and teamwork," commented Olmstead, president of the Association for Professionals in Infection Control and Epidemiology, which was involved with the development of the guidelines.

The updated guidelines are "an important resource to support efforts toward the elimination of catheter-related bloodstream infections," Olmstead said in a statement.

Development of the guidelines was supported by the CDC with the involvement of academic and medical societies. O'Grady reported no financial links with industry.

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